Nonchalant Midterm-taker Develops Altered Mental Status (slideshow)

A 19 year-old female presented in April 2016 with two weeks of worsening headaches, malaise, left-hand weakness, and confusion. Symptoms started during a trip to Cancun and one week after visiting a friend with mumps. Although she was becoming increasingly lethargic, she refused to seek medical attention during midterm exams.Patient Care, Medical Knowledge, PBLI, SBP, Professionalism, IPCS, KBDdoonparaneoplastic, KBDparaneoplasticdiseas

Nonchalant Midterm-taker Develops Altered Mental Status (video)

A 19 year-old female presented in April 2016 with two weeks of worsening headaches, malaise, left-hand weakness, and confusion. Symptoms started during a trip to Cancun and one week after visiting a friend with mumps. Although she was becoming increasingly lethargic, she refused to seek medical attention during midterm exams.Patient Care, Medical Knowledge, PBLI, SBP, Professionalism, IPCS, KBDdoonparaneoplastic, KBDparaneoplasticdiseas

Nonchalant Midterm-taker Develops Altered Mental Status (abstract)

A 19 year-old female presented in April 2016 with two weeks of worsening headaches, malaise, left-hand weakness, and confusion. Symptoms started during a trip to Cancun and one week after visiting a friend with mumps. Although she was becoming increasingly lethargic, she refused to seek medical attention during midterm exams.Patient Care, Medical Knowledge, PBLI, SBP, Professionalism, IPCS, KBDdoonparaneoplastic, KBDparaneoplasticdiseas

Back to Basics (.pdf)

A 71 year-old female with an unremarkable medical history was referred for evaluation of progressive painless vision loss in her left eye. An outside corneal specialist had diagnosed Fuch's corneal dystrophy. She had undergone cataract extraction OS, DSEK OS, and then repeat DSEK OS after the initial graft failed. However, the patient's vision had not improved following the surgery. Rather, her vision had worsened. On examination, visual acuity was 20/30 OD and HM OS. External examination showed 4 mm proptosis OS and ptosis OS. Motility was full OU. There was a 2.8 log unit RAPD OS. Anterior segment examination showed changes consistent with Fuch's corneal dystrophy, an endothelial graft OS, and a partially dislocated posterior chamber intraocular lens OS. Dilated funduscopic examination showed mild temporal optic disc pallor OD and moderate optic disc pallor OS. Goldmann visual field testing showed an inferior arcuate defect with generalized depression OD and a small nasal island of vision OS. MRI orbits with contrast showed bilateral. On enhancing inferior orbital soft tissue masses involving both inferior recti and infraorbital nerves, extending into both cavernous sinuses. Although there was a broad differential diagnosis, the MRI findings were felt to be most consistent with orbital inflammatory disease, possibly IgG4-related disease. A laboratory work-up was obtained, including CBC, basic metabolic panel, ESR, CRP, ANCA, and syphilis serology. Most of the studies were unrevealing, but the ESR was elevated at 38 mm/hr. A diagnostic test was then performed

IgG4-related disease in an adolescent with radiologic-pathologic correlation

Immunoglobulin G4–related disease (IgG4RD) is an immune-mediated condition characterized by lymphoplasmacytic infiltrates and fibrosis of affected organs. IgG4RD may affect many different organs either individually or together in a multiorgan condition and, thus, incorporates a wide range of fibroinflammatory phenotypes with shared pathologic features. Although IgG4RD most commonly occurs in late adulthood, it may affect children and adolescents. Only one case of IgG4RD presenting as isolated submandibular gland involvement has been reported in the pediatric population. Radiographic features of IgG4RD are often nonspecific making diagnosis challenging, but it is important for radiologists to be familiar with this diseased as its inclusion the differential for diffuse salivary enlargement may be the first step in making an accurate diagnosis. Here, we report a case of a child presenting with bilateral submandibular gland swelling to increase awareness of this condition in the pediatric population. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors